Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

Being “in the shadows” has long been a healthcare access issue. The broken healthcare system has been aggravated by a broken immigration system. Immigration and healthcare are tied together in many ways, especially for the economically disadvantaged.

According to the New York Times:

What Is President Obama’s Immigration Plan?

President Obama announced on Thursday evening a series of executive actions to grant up to five million unauthorized immigrants protection from deportation. The president is also planning actions to direct law enforcement priorities toward criminals, allow high-skilled workers to move or change jobs more easily, and streamline visa and court procedures, among others. NOV. 20, 2014 RELATED ARTICLE

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Who could be affected?

The president’s plan is expected to affect up to five million of the nation’s unauthorized immigrant population, currently 11.4 million according to the Migration Policy Institute. It would create a new program of deferrals for approximately 3.7 undocumented parents of American citizens or legal permanent residents who have been in the country for at least five years. Deferrals would include authorization to work and would be granted for three years at a time.

It would also expand a program created by the administration in 2012 called Deferred Action for Childhood Arrivals, or DACA, which allows young people who were brought into the country as children to apply for deportation deferrals and work permits. The plan would extend eligibility to people who entered the United States as children before January 2010 (the cutoff is currently June 15, 2007). It would also increase the deferral period to three years from two years and eliminate the requirement that applicants be under 31 years old. About 1.2 million young immigrants are currently eligible, and the new plan would expand eligibility to approximately 300,000 more.

The Kaiser Family Foundation has released its first survey of the population finding new health coverage under the recently implemented ACA reform. The survey delineates two main groups taking advantage of the increased access to health insurance: those who had non-group coverage and those who had no insurance at all. The experiences of these two groups may prove important, the report goes on to say, with significant implications on how the success of the ACA reform is judged.

Apparently, the success of the ACA reform in brining people into the insured fold may be limited by financial literacy, insurance literacy, and health literacy deficits evident in the Kaiser Family Foundation survey.

A preliminary read of the survey report findings by The Policy ThinkShop points to an emergent need to address health literacy in the newly covered group in order to ensure that coverage recipients understand how to take advantage of their presumed efficacy in the insurance market and in their presumed increased access to healthcare itself and cost saving prevention health services. According to the survey:

“Health insurance is complicated, and many previous studies have documented gaps in health insurance literacy among consumers. The survey finds evidence of this among those who purchase their own coverage, with many respondents unable to answer some basic questions about their plans. For example, nearly one in five non-group enrollees (18 percent) say they don’t know the amount of their monthly premium and almost four in ten (37 percent) don’t know the amount of their annual deductible. Among those with ACA-compliant plans, three in ten (30 percent) say they don’t know the metal level of their plan (platinum, gold, silver or bronze), and among those who report getting a government subsidy to defray their premium cost, nearly half (47 percent) couldn’t say what the amount of the subsidy is.”

The survey report goes on to highlight the segment of the population surveyed who are more privileged because of their prior experience obtaining insurance:

“Some groups are more knowledgeable than others, including college graduates, those with higher incomes, and small business owners. Plan switchers, who likely have more experience buying coverage in the non-group market, are also more likely than those who were previously uninsured to be able to report the metal level of their plan and their premium and deductible amounts.”

“January 1, 2014 marked the beginning of several provisions of the Affordable Care Act ACA making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces also known as “Exchanges” and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage non-group or otherwise.”

When you visit your doctor does (s)he look happy? At the end of the day healthcare is a one on one personal experience. All the insurance coverage or fancy machines in the world won’t improve medical care if the doctor patient relationship is not optimal.

So what is our healthcare system doing to address physician happiness? The Gallup organization took a closer look at hospitals, one place where physician practice is defined and sustained–for better or for worse…

“When doctors are frustrated, patient care and hospital revenues suffer. Heres how hospitals can engage their physicians — and make a positive impact on patients and the bottom line.”

Like most semantically charged (politicized) issues in our public policy conversations, immigration is usually looked at from the perspective of some aggrieved or troubled constituency. Too often it is the cannon fodder of political battles resonating in the popular canons of the dominant culture.

The Policy ThinkShop seeks to help shed reason and light on all matters impacting families and children caught in the crossfire of pursuing the American Dream while experiencing all of the vulnerabilities that come from escaping economic adversity while becoming one of the most reviled and manipulated symbols within America’s troubling debate over who belongs here and who does not. According to The Urban Institute (a bipartisan think tank in DC) the demographics of immigration are changing and, one should consider, that if the players (or pawns) change so will the immigration policy debate.

If we are going to hear the voice of reason and stay true to America’s love for:

“Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!”

… then we better get busy understanding and participating in the current decision to lock unauthorized immigrants from the benefits of our healthcare system. Important and “here to stay” segments of this large group (perhaps as many as 11 million) will continue to show up in emergency rooms and make important demands on local public health infrastructures.

What may seem prudent in today’s austere and sluggish economy may prove a pound foolish in the not too distant future…

“Today’s unauthorized immigrants are older, better educated, more geographically dispersed, have more diverse country-of-origin backgrounds, and have spent more time in the United States than unauthorized immigrants who legalized under the Immigration Reform and Control Act of 1986 (IRCA). Nevertheless, the wage gap between unauthorized immigrants and native-born workers is wider today than it was in 1986. Policymakers must keep such differences in mind when using IRCA to anticipate the impacts of legalization programs today and making decisions about how to implement such programs.”

“Fall 2013 will begin to usher in the key health insurance coverage expansions of the Affordable Care Act (ACA), with open enrollment in new health insurance Marketplaces beginning on October 1, 2013, and Medicaid expanding to adults in states moving forward with the ACA Medicaid expansion as of January 1, 2014. During summer 2013, with open enrollment rapidly approaching, many states were in high gear to finalize preparations for outreach and enrollment efforts to help translate these new coverage options into increased coverage for millions of currently uninsured individuals. This report provides insight into preparations in Maryland, Nevada, and Oregon -three states that have established a State-based Marketplace, are moving forward with the Medicaid expansion, and are among the states leading the way in preparing for outreach and enrollment. The findings provide an overview of where these three states are in establishing their Marketplaces; preparing for the Medicaid expansion; planning for marketing, outreach and enrollment; and establishing enrollment assistance resources. They also highlight the challenges that states have encountered and overcome, the successes they have achieved, and the key lessons that may help inform implementation efforts moving forward.”via Getting into Gear for 2014: Insights from Three States Leading the Way in Preparing for Outreach and Enrollment in the Affordable Care Act | The Henry J. Kaiser Family Foundation.

You are a leader… Whether it is for your family, your organization or your company, you need to have a handle on healthcare reform.

The following is a quick guide you can use and share with others in your efforts to stay “intelligent” on the often confusing and misinformed healthcare debate vs. what the law now being implemented really is…

The Kaiser Foundation has some of the most current and accurate information available on this important subject.

Here is a quick guide to what you need to know about them:

1.

The insurance marketplaces are open to nearly everyone, but If you have insurance through work, Medicare or Medicaid, it’s likely you won’t need to shop for coverage there. They are really for people who are uninsured or folks who buy individual policies now.

2.

Many people will qualify for subsidies to make coverage more affordable there. These subsidies – tax credits to help pay your premiums – will be available to people with incomes up to 400 percent of the federal poverty level. That\’s about $46,000 for one person or $94,000 for a family of four. And there are cost-sharing subsidies to reduce deductibles and copayments, depending on your income.

3.

Immigrants who are in this country illegally are barred from buying on the exchanges.

4.

You can enroll until March 31, 2014, though you\’ll generally need to sign up by Dec. 15 of this year, to be covered as of Jan. 1. You can find your state’s marketplace at healthcare.gov.

5.

Through the marketplace, you can compare health plans in your area. The prices are based on where you live, your family size, the type of plan you select, your age and whether you smoke. All the plans have to comply with the Affordable Care Act’s requirement to have a basic benefits package, but the amount you have to pay in premiums, co-pays and deductibles will vary among plans.

6.

When you apply for coverage on the exchange, you will find out if you’re eligible for subsidies to help pay for premiums. Or, if you have a low income, you can also learn if you are eligible for Medicaid coverage.

7.

Your income — not your assets, such as your house, stocks or retirement accounts – will count toward determining whether you can get tax credits. When you buy your plan, you estimate your income for next year, and your tax credit is based on that estimate. The next year, your tax returns will be checked by the IRS and compared against your estimate.

8.

If you qualify for a tax credit to pay your premiums, you can choose to either have the credit sent directly to the insurer or pay the whole premium up front and claim the credit on your taxes. If you qualify for cost-sharing subsidies, that subsidy will be sent directly to the insurer, and you won’t have to pay as much out of pocket.

9.

If your income increases during the year, notify the exchange promptly so that you can avoid having to pay back the credits. On the other hand, if your income goes down, you could be eligible for a bigger subsidy. Either way it\’s important to notify the exchange if your income changes.

10.

Each plan covers 10 “essential health benefits,” which include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services, such as mammograms, must be covered without any out-of-pocket costs to you.

11.

You won’t have to pay more for insurance if you have a medical condition and that condition will be covered when your policy begins. But older people can be charged more than younger people and smokers could face a surcharge.

12.

The prices for the marketplace plans are likely to be similar to those sold privately. If your broker offers you a plan that is also available on the exchange, you may be eligible for subsidies.

13.

Your insurer generally can\’t drop you, as long as you keep up with your insurance premiums and don\’t lie on your application. Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, running from October 15 to December 7.

14.

There are certain circumstances when you would be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job, for example, or get married, divorced or have a child.

15.

The number of plans that you can choose from is likely to vary widely. In some states, only a couple of insurers have announced plans to offer policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. You can expect that insurers will offer a variety of types of plans, including familiar models like PPOs and HMOs.

One of our Policy ThinkShop bloggers posting on other social media regarding poverty policy, or the lack there of, in our country ….

Thanks for the report updating the latest ideas on our ongoing discourse on poverty and for getting us to think about the important connections between education, poverty and health.

The report rehashes, mostly academic, arguments regarding race, statistics, the infamous 1969 poverty measure and the poverty measure’s successive fabrications. I was in graduate school at the University of Chicago in the mid 80s when William J. Wilson led a “one man band” against the Reagan Administration’s and Charles Murray’s assault on “the welfare state, the welfare mother, and so on…”

I sat in Prof. Gary Orfield’s office one day while he fielded a call from the then Ronald Reagan stacked Civil Rights Commission which Prof. Orfield was a member of. It was a turning point for me in how I would henceforth see the role that well-meaning advocates play in our government’s institutions. After nearly four decades experiencing health and human services policy and planning in our nation’s state and local systems, that lesson still holds—facts are not enough, we must do. The problem becomes who is the “we”?

The Policy ThinkShop is expanding its policy analysis and research resources in response to the current healthcare reform challenges faced by the states and communities. We will be posting periodic articles and resources addressing the numerous variables that define the nation’s current healthcare challenges which go well beyond putting a health insurance card in a person’s hand.

for more health specific resources and to share with us which areas of health you want us to address for your daily health administration, policy and planning needs.

The restaurant industry can be seen as fitting into a continuum. At one extreme are the restaurants that focus on providing easy to make menus, easy to store foods, easy to please customers. By easy to please we might mean people who are looking for the basic satisfying elements producing the classic “addictive” flavors from sweets, salts and fatty foods. At the other extreme, difficult to call it “extreme” since it is probably the more reasonable in terms of healthy lifestyle, there is the fresh vegetables, fish and light fowl, moderately portioned cuisine served in prestigious and select culinary establishments for the educated palate. Home cooking has historical and culturally embedded positive meaning in our culture but truth be told most home cooking is not very healthy either… In this case, it probably goes outside our initial restaurant continuum because cooking at home requires skill, time and appropriate ingredients. Of course, in the available ingredients we find the most difficult challenge. Keeping fresh vegetables, fish and fowl on hand is to often cumbersome and expensive. Although budget is often the decisive factor here, time, a more universally unavailable commodity, is often the thing that makes or breaks home cooking.

Aside from the mechanics, logistics and administrative aspects of culinary efficacy there is, perhaps equally decisive as time, health literacy. That is, knowledge of the relationship between food and health. That is not the only aspect of health literacy but it just as well aught to be. According to the Gallop Poll, knowledge about what we eat is woefully missing in the American culinary mind.

The Policy ThinkShop is expanding its policy analysis and research resources in response to the current healthcare reform challenges faced by the states and communities. We will be posting periodic articles and resources addressing the numerous variables that define the nation’s current healthcare challenges which go well beyond putting a health insurance card in a person’s hand.

for more health specific resources and to share with us which areas of health you want us to address for your daily health administration, policy and planning needs.

“Even as more U.S. restaurants list nutritional information on their menus, less than half of Americans, 43%, say they pay a “great deal” or a “fair amount” of attention to it. Americans are much more likely to take note of nutritional labels on food packages, with 68% saying they pay at least a fair amount of attention to this …”

The Kaiser Family Foundation policy research on medicaid expansion and the implementation of the current healthcare reform is very optimistic and useful. However, it would be prudent to look at the local healthcare infrastructure’s ability to both create (healthcare outreach) and meet the new demand for the coverage that the healthcare act promises. Indeed, a decade of the most draconian recession in recent history has not helped the public health sector to recruit and diversify its workforce in order to be ready to take on the potential numbers of Latinos, for example, who would benefit disproportionately from the new access as they are over represented in the labor and business sectors that currently provide jobs without health benefits. According to the Kaiser Family Foundation, the healthcare reform picture is quite rosy, but for Latinos healthcare reform may not be quite the rose garden envisioned by current mainstream health policy pundits. The Policy ThinkShop

According to the Kaiser Foundation:

“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in evaluating the ACA Medicaid expansion are:

1. What are the fiscal implications of the ACA Medicaid expansion for states?

Overall, many states are likely to see net savings from the Medicaid expansion.

The Medicaid expansion also may have positive economic effects for states like increased jobs, revenues or economic activity.

Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.

Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program. Congress has only amended the formula to provide more federal funding, not less.

2. What effect will the Medicaid expansion have on coverage?

The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.

A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people. Despite claims to the contrary, research points to improved outcomes and reduced mortality from Medicaid coverage.

Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion.

For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.

3. What flexibilities do states have in implementing the Medicaid expansion?

States have considerable flexibility to administer traditional Medicaid programs.

Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.

Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.

States also continue to have ability to seek approval for demonstration waivers. Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.”

American demographics are being transformed by recent recessionary pressures on migration patterns. Also, Latino Americans have not only been growing numerically but in terms of being an increasingly larger portion of the populous for a significant period of time. We don’t have to be social historians to see it. It is increasingly evident. This means that the American social landscape is significantly becoming more Latino, especially in markets, cities, states and regions where Latinos have been a significant part of the polity and are beginning to have a voice. The implications for the coming elections, healthcare reform and workforce development needs, for example, are increasingly being discussed. The Pew Center for Research does a fine job of keeping us posted, along with The Policy ThinkShop, on these matters …

“The language of news media consumption is changing for Hispanics: a growing share of Latino adults are consuming news in English from television, print, radio and internet outlets, and a declining share are doing so in Spanish, according to survey findings from the Pew Research Center.

In 2012, 82% of Hispanic adults said they got at least some of their news in English,1 up from 78% who said the same in 2006. By contrast, the share who get at least some of their news in Spanish has declined, to 68% in 2012 from 78% in 2006.2

Half (50%) of Latino adults say they get their news in both languages, down from 57% in 2010.

The rise in use of English news sources has been driven by an increase in the share of Hispanics who say they get their news exclusively in English. According to the survey, one-third (32%) of Hispanic adults in 2012 did this, up from 22% in 2006. By contrast, the share of Hispanic adults who get their news exclusively in Spanish has decreased to 18% in 2012 from 22% in 2006.

These changes in news consumption patterns reflect several ongoing demographic trends within the Hispanic community. For example:

A growing share of Latino adults speak English well. Today 59% of Latino adults speak English proficiently, up from 54% in 2006 and 2000, according to U.S. Census Bureau data.

Slowing immigration. As migration to the U.S. has slowed (Passel, Cohn and Gonzalez-Barrera, 2012), the share of Hispanic adults who are foreign born has declined. Today about 51% of Hispanic adults were born in another country, down from 55% in 2006 and 54% in 2000, according to U.S. Census Bureau data.

Growing time in the U.S. With the slowdown in migration, the average number of years lived in the U.S. among Latino adult immigrants has grown, from 16 years in 2000 and 17 years in 2006 to 20 years in 2011.

U.S.-born Latino adults on the rise. Annually about 800,000 young U.S.-born Latinos enter adulthood (Taylor, Gonzalez-Barrera, Passel and Lopez, 2012). Many are the children of immigrants, and a significant share are third or higher generation. These groups are much more English proficient than are immigrants.”

Historically, if you have a job, although you may barely have enough to pay rent and feed your family, you cannot qualify for help with the high cost of healthcare for your growing family.

The expansion of Medicaid means that people who struggle in low paying jobs will be able to qualify for healthcare at reasonable rates for them or their employers under the new expansion made possible by the current ACA healthcare reform (Obama Care).

Hispanics are the nation’s largest growing majority and are increasingly becoming the largest group in many of the nation’s cities and states. Ironically, a disproportionate majority of the people who qualify for Medicaid expansion, will be Hispanics/Latinos, who tend to work at low paying/low benefit jobs that do not currently provide benefits, much less health benefits, for their growing families. Obama care offers incentives and eventually legal mandates for employers and individuals to avail themselves of local health care access opportunities. States must step up to the plate and help create and/or support these local healthcare access opportunities. The Federal government must be held accountable, though, to continue to support these efforts and not leave the states on their own–especially in these times of recession and low state tax collection due to a recessionary economy.

What is at stake is the healthcare coverage that is needed by millions of mothers and children who will otherwise be punished for taking low paying, low benefit jobs. Hispanics/Latinos are not rewarded by our society for having high labor force participation rates. The states need to take a long look at the implementation for the ACA and see it as an opportunity to invest in today’s young Latinos/Hispanics who are becoming an important part of the American mosaic and our future.

“As states wrap up legislative sessions and make decisions about whether to implement the Medicaid expansion included in the Affordable Care Act (ACA), this new analysis highlights the implications of these decisions for coverage, state finances and providers. As of July 2013, 24 states were moving forward with the Medicaid expansion, 21 states were not moving forward with the expansion and debate was on-going in the remaining 6 states. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave many more uninsured; these states would also forgo billions in federal funds.”

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